When Percutaneous Dilation Tracheotomy Maybe Hazardous: Abnormal Course of the Brachiocephalic Trunk

Introduction Percutaneous dilatational tracheotomy (PDT) is becoming increasingly popular in present day critical care medicine. In contrast to the surgical approach, PDT involves a blind puncture and dilation of the pretracheal space, which may predispose to dangerous complications in the case of a...

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Bibliographic Details
Published in:Neurocritical care 2009-06, Vol.10 (3), p.336-338
Main Authors: Minnerup, Jens, Summ, Oliver, Oelschlaeger, Christian, Niederstadt, Thomas, Dittrich, Ralf, Kleinheinz, Johannes, Dziewas, Rainer
Format: Article
Language:English
Subjects:
Anesthesia
Critical Care Medicine
Dysphagia
Fistula
Intensive
Intensive care
Internal Medicine
Intubation
Medical imaging
Medicine
Medicine & Public Health
Neurology
Ostomy
Patients
Pneumonia
Practical Pearl
Stroke
Systematic review
Thyroid gland
Tracheotomy
Ultrasonic imaging
Veins & arteries
Ventilators
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Summary:Introduction Percutaneous dilatational tracheotomy (PDT) is becoming increasingly popular in present day critical care medicine. In contrast to the surgical approach, PDT involves a blind puncture and dilation of the pretracheal space, which may predispose to dangerous complications in the case of anatomical, in particular vascular, anomalies. Methods and Results We report on two patients, in whom an abnormal pulsation was detected when the infracricoid region was palpated in preparation for PDT. An immediately performed ultrasound scan revealed an arterial blood vessel in front of the upper part of the trachea. A subsequent CT-angiography showed an anomalous course of the brachiocephalic trunk. While too dangerous for PDT, the local department of cranio-maxillofacial surgery was consulted for surgical tracheotomy. Conclusion To avoid hazardous bleeding complications in PDT we recommend at least an ultrasound scan in case of an abnormal pulsation and an enlarged thyroid gland.
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-009-9210-3